ACT Center supports innovation in cancer screening
How Kaiser Permanente Washington is using learning health system research to make cervical cancer screening easier
November 11, 2024
ACT Center supports innovation in cancer screening
Beverly Green (L) and Brandi Crawford-Gallagher visit Silverdale Medical Center as part of the ACT Center’s
evaluation of Kaiser Permanente Washington’s new cervical cancer screening program.
How Kaiser Permanente Washington is using learning health system research to make cervical cancer screening easier
By Jess Mogk, MPH, a collaborative scientist with the Center for Accelerating Care Transformation (ACT Center) at Kaiser Permanente Washington Health Research Institute
Nearly all cervical cancers can be prevented by finding and removing precancers caused by certain high-risk strains of the human papillomavirus (HPV). With HPV screening rates declining nationwide since the onset of COVID-19, it’s more important than ever to make screening easier for patients.
In partnership with the University of Washington, Kaiser Permanente Washington physician-researcher Beverly Green, MD, co-led federally funded research showing that more people completed HPV screening when their care teams mailed screening kits to their homes, and the test results were as accurate as screening completed in clinic. Published in the Journal of the American Medical Association (JAMA), this groundbreaking research is helping shape the future of cervical cancer prevention for Kaiser Permanente members and for communities worldwide.
Leaders at Kaiser Permanente Washington acted quickly to put this research into action. All members 30 to 64 years old who are at average risk for cervical cancer and due for screening are now mailed HPV screening kits that they can complete in the comfort of their homes. And through the organization’s Learning Health System Program, the innovations continue. I’m excited to be co-leading the ACT Center team that is evaluating the uptake and effectiveness of HPV home testing so we can keep improving this valuable service for members and leading the way in cancer prevention.
Evaluating and improving the new self-collect HPV program
Leaders in Quality and Population Health at Kaiser Permanente Washington launched the self-collect HPV screening program in the summer of 2023. By early 2024, they were eager to get feedback and find opportunities to improve. So they asked the ACT Center to launch a rapid evaluation — which involved completing everything from project scoping to results and recommendations in less than 9 months.
Despite our tight timeline, we found ways to take a holistic approach to the work, successfully collaborating with several teams that contribute to the self-collect HPV program across Kaiser Permanente Washington. One of our first activities was to tour the lab, document how self-collect HPV samples are received and analyzed, and identify opportunities to improve the process. Next, we interviewed 16 clinic leaders and providers to learn about their experiences with the program and the feedback they’ve heard from patients.
Importantly, screening for HPV leads to crucial next steps — for example, tracking results and following up with members whose results are abnormal. So we also looked at the inner workings of the electronic health record to see how automated reminders and results tracking were functioning.
Our forthcoming quantitative analysis will illuminate changes in screening completion before and after implementation. We are especially interested in learning how effective the program is for members who have never completed cervical cancer screening before or who are from populations who tend to have lower screening rates. So far, our findings suggest that certain members, like those who have never completed cervical cancer screening, might need additional information or support.
Adapting and enhancing the program in real time
When a program moves from a research setting to standard health care practice, some aspects of the program may need to change to fit real-world constraints. Our partners across Kaiser Permanente Washington have been thoughtful and proactive as they considered ways to adapt the program for everyday care.
For example, in the research leading up to the self-collect HPV program, a nurse was assigned to follow up with people who had abnormal results to help them schedule follow-up testing. As the program was implemented as part of standard care, this same nurse remained responsible for these activities — but with far more tests to follow up on and less dedicated time for this work. Care delivery leaders took action to improve the process by automating follow-up messaging to members who needed a second test because their initial results were inconclusive (1% to 2% of tests). This freed up time for the nurse to spend with other patients who needed important follow-up testing.
To date, our evaluation has shown that the new process is both more efficient and more effective: 80% of patients who were screened in the new program and needed additional follow-up testing after a positive result completed this testing — compared to 64% in the JAMA study.
Other recent changes to the program have given us an opportunity to learn more about what works best to boost screening rates. One simple example relates to how members fill out the written information that accompanies a self-collect screening sample. Our partners in the lab pointed out that many self-collect HPV tests were being mailed in without a collection date written down, which was causing delays in sample processing and led to some samples needing to be discarded. Our ACT Center team suggested changes to the self-collect instructions to emphasize the date, and now we’re tracking whether that helps decrease these delays.
Most importantly, the program is continuing to tap into ideas from care teams and patients to develop a program that improves cervical cancer detection by making screening as easy as possible for members. For example, as the home testing program was being implemented, clinicians noted that self-collect tests should also be available in the clinic. Based on this suggestion, the program now includes an option for providers to order self-collect tests for patients to use during a clinic visit or at home.
We visited 3 medical centers to learn how they are leveraging this option to help patients complete cervical cancer screening even if their visit was prompted by another health care concern. To date, our evaluation has shown that offering the self-collect option during clinic visits helps us achieve a higher rate of completed tests than only sending test kits by mail. This suggests having multiple options for members is the ideal way to increase screening.
Partnerships for spread and scale
The ACT Center will share final results and recommendations with our partners at Kaiser Permanente Washington in December, and we hope to publish what we’ve learned in an academic journal so others working to improve cancer screening can benefit from our experience.
Since Kaiser Permanente serves communities in 8 regions across the country, this project has opened up opportunities for partnership and cross-collaboration. The ACT Center was able to leverage important qualitative research findings from Kaiser Permanente’s Northwest and Colorado regions to inform our work — and now we’re sharing with them the tools we’ve developed to support larger-scale implementation. As other Kaiser Permanente regions aim to make cervical cancer screening easier for members, this project serves an important guidepost for a new standard of care. It’s exciting to think that an innovation that started with our research here in Washington could become standard care across Kaiser Permanente, and even beyond.
We are grateful to the following project partners for their collaboration and hard work:
